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  1. The Harms of the Internalized Oppression Worry.Nicole Dular & Madeline Ward - forthcoming - Journal of Social Philosophy.
    In this paper, we locate a general rhetorical strategy employed in theoretical discourse wherein philosophers argue from the mere existence of internalized oppression to some kind of epistemic, moral, political, or cognitive deficiency of oppressed people. We argue that this strategy has harmful consequences for oppressed people, breaking down our analysis in terms of individual and structural harms within both epistemic and moral domains. These harms include attempting to undermine the self-trust of oppressed people, reinforcing unjust epistemic power hierarchies, undermining (...)
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  • Principlism and Contemporary Ethical Considers in Transgender Health Care.Luke Allen, Noah Adams, Florence Ashley, Cody Dodd, Diane Ehrensaft, Lin Fraser, Maurice Garcia, Simona Giordano, Jamison Green, Thomas Johnson, Justin Penny, Rachlin Katherine & Jaimie Veale - forthcoming - International Journal of Transgender Health.
    Background: Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims: We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender (...)
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  • Gender Affirming Hormone Treatment for Trans Adolescents: A Four Principles Analysis.Hane Htut Maung - 2024 - Journal of Bioethical Inquiry:1-19.
    Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender affirming hormone treatment (...)
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  • What Is It like to Have a Gender Identity?Florence Ashley - 2023 - Mind 132 (528):1053-1073.
    By attending to how people speak about their gender, we can find diverse answers to the question of what it is like to have a gender identity. To some, it is little more than having a body whereas others may report it as more attitudinal or dispositional—seemingly contradictory views. In this paper, I seek to reconcile these disparate answers by developing a theory of how individual gender identity comes about. In the simplest possible terms, I propose that gender identity is (...)
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  • Integrity and rights to gender-affirming healthcare.R. Rowland - 2022 - Journal of Medical Ethics 48 (11):832-837.
    Gender-affirming healthcare interventions are medical or surgical interventions that aim to allow trans and non-binary people to better affirm their gender identity. It has been argued that rights to GAH must be grounded in either a right to be cured of or mitigate an illness—gender dysphoria—or in harm prevention, given the high rates of depression and suicide among trans and non-binary people. However, these grounds of a right to GAH conflict with the prevalent view among theorists, institutions and activists that (...)
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  • Enhancing Gender.Hazem Zohny, Brian D. Earp & Julian Savulescu - 2022 - Journal of Bioethical Inquiry 19 (2):225-237.
    Transgender healthcare faces a dilemma. On the one hand, access to certain medical interventions, including hormone treatments or surgeries, where desired, may be beneficial or even vital for some gender dysphoric trans people. But on the other hand, access to medical interventions typically requires a diagnosis, which, in turn, seems to imply the existence of a pathological state—something that many transgender people reject as a false and stigmatizing characterization of their experience or identity. In this paper we argue that developments (...)
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  • Responding to objections to gatekeeping for hormone replacement therapy.Toni C. Saad, Daniel Rodger & Bruce Philip Blackshaw - 2019 - Journal of Medical Ethics 45 (12):828-829.
    Florence Ashley has responded to our response to ‘Gatekeeping hormone replacement therapy for transgender patients is dehumanising.’ Ashley criticises some of our objections to their view that patients seeking hormone replacement therapy (HRT) for gender dysphoria should not have to undergo a prior psychological assessment. Here we clarify our objections, most importantly that concerning the parity between cosmetic surgery and the sort of intervention Ashley has in mind. Firstly, we show Ashley’s criticism of our comparison is insubstantial. We then examine (...)
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  • Hormone replacement therapy: informed consent without assessment?Toni C. Saad, Bruce Philip Blackshaw & Daniel Rodger - 2019 - Journal of Medical Ethics 45 (12):1-2.
    Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic surgery (...)
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  • Gender dysphoria in adolescents: can adolescents or parents give valid consent to puberty blockers?Simona Giordano, Fae Garland & Soren Holm - forthcoming - Journal of Medical Ethics.
    This article considers the claim that gender diverse minors and their families should not be able to consent to hormonal treatment for gender dysphoria. The claim refers particularly to hormonal treatment with so-called ‘blockers’, analogues that suspend temporarily pubertal development. We discuss particularly four reasons why consent may be deemed invalid in these cases: the decision is too complex; the decision-makers are too emotionally involved; the decision-makers are on a ‘conveyor belt’; the possibility of detransitioning. We examine each of these (...)
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  • What Is the Aim of Pediatric “Gender‐Affirming” Care?Moti Gorin - 2024 - Hastings Center Report 54 (3):35-50.
    The original “Dutch Protocol”—the treatment model comprised of puberty blockers, cross‐sex hormones, and surgery—was intended to improve the mental and physical health of pediatric patients experiencing distress over their sexed bodies. Consequently, both researchers and clinicians have couched eligibility for treatment and measures of treatment efficacy in terms of the interventions’ effects on outcomes such as gender dysphoria, depression, anxiety, and suicide. However, recent systematic reviews have concluded that the scientific evidence supporting these interventions is uncertain, leading to significant international (...)
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  • Youth should decide: the principle of subsidiarity in paediatric transgender healthcare.Florence Ashley - 2023 - Journal of Medical Ethics 49 (2):110-114.
    Drawing on the principle of subsidiarity, this article develops a framework for allocating medical decision-making authority in the absence of capacity to consent and argues that decisional authority in paediatric transgender healthcare should generally lie in the patient. Regardless of patients’ capacity, there is usually nobody better positioned to make medical decisions that go to the heart of a patient’s identity than the patients themselves. Under the principle of subsidiarity, decisional authority should only be held by a higher level decision-maker, (...)
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  • This Wasn’t a Split-Second Decision”: An Empirical Ethical Analysis of Transgender Youth Capacity, Rights, and Authority to Consent to Hormone Therapy.Beth A. Clark & Alice Virani - 2021 - Journal of Bioethical Inquiry 18 (1):151-164.
    Inherent in providing healthcare for youth lie tensions among best interests, decision-making capacity, rights, and legal authority. Transgender youth experience barriers to needed gender-affirming care, often rooted in ethical and legal issues, such as healthcare provider concerns regarding youth capacity and rights to consent to hormone therapy. Even when decision-making capacity is present, youth may lack the legal authority to give consent. The aims of this paper are therefore to provide an empirical analysis of minor trans youth capacity to consent (...)
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  • Studying Vulnerable Populations Through an Epigenetics Lens: Proceed with Caution.Katie Saulnier, Alison Berner, Stamatina Liosi, Brian Earp, Courtney Berrios, Stephanie O. M. Dyke, Charles Dupras & Yann Joly - 2022 - Canadian Journal of Bioethics / Revue canadienne de bioéthique 5 (1).
    Epigenetics – the study of mechanisms that influence and modify gene expression – is providing unique insights into how an individual’s social and physical environment impact the body at a molecular level, particularly in populations that experience stigmatization and trauma. Researchers are employing epigenetic studies to illuminate how epigenetic modifications lead to imbalances in health outcomes for vulnerable populations. However, the investigation of factors that render a population epigenetically vulnerable present particular ethical and methodological challenges. Here we are concerned with (...)
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  • Re-assessing the Triadic Model of Care for Trans Patients Using a Harm-Reduction Approach.A. F. Gruenewald - 2020 - Health Care Analysis 28 (4):415-423.
    The World Professional Association for Transgender Health’s Standards of Care, now in its seventh edition, is a frequently cited, internationally recognized, evidence-based document that details a comprehensive framework for gender-related care of trans people. However, the WPATH SOC still relies heavily in some cases on gatekeeping practices, dubbed “triadic therapy,” or a process where a trans patient is encouraged to seek out psychotherapy, and hormone therapy, and only then be able to engage in surgical options for transitioning. I use G. (...)
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  • Identity, well-being and autonomy in ongoing puberty suppression for non-binary adults: a response to the commentaries.Lauren Notini, Brian D. Earp, Lynn Gillam, Julian Savulescu, Michelle Telfer & Ken C. Pang - 2020 - Journal of Medical Ethics 46 (11):761-762.
    We thank the commentators for their thoughtful responses to our article.1 Due to space constraints, we will confine our discussion to just three key issues. The first issue relates to the central ethical conundrum for clinicians working with young people like Phoenix: namely, how to respect, value and defer to a person’s own account of their identity and what is needed for their well-being, while staying open to the possibility that such an account may reflect a work in progress. This (...)
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  • GnRHa (‘Puberty Blockers’) and Cross Sex Hormones for Children and Adolescents: Informed Consent, Personhood and Freedom of Expression.David Pilgrim & Kirsty Entwistle - 2020 - The New Bioethics 26 (3):224-237.
    Ethical concerns have been raised about routine practice in paediatric gender clinics. We discuss informed consent and the risk of iatrogenesis in the prescribing of gonadotropin-releasing hormone...
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  • Reply to ‘Hormone replacement therapy: informed consent without assessment?’.Florence Ashley - 2019 - Journal of Medical Ethics 45 (12):826-827.
    In a previous article, I argued that assessment requirements for transgender hormone replacement therapy are unethical and dehumanising. A recent response published by the Journal of Medical Ethics criticises this proposal. In this reply, I advance that their response misunderstood core parts of my argument and fails to provide independent support for assessment requirements. Though transition-related care may have similarities with cosmetic surgeries, this does not suffice to establish a need for assessments, and nor do the high rates of depression (...)
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  • Gender Transition: Is There a Right to Be Forgotten?Mónica Correia, Guilhermina Rêgo & Rui Nunes - 2021 - Health Care Analysis 29 (4):283-300.
    The European Union faced high risks from personal data proliferation to individuals’ privacy. Legislation has emerged that seeks to articulate all interests at stake, balancing the need for data flow from EU countries with protecting personal data: the General Data Protection Regulation. One of the mechanisms established by this new law to strengthen the individual’s control over their data is the so-called “right to be forgotten”, the right to obtain from the controller the erasure of records. In gender transition, this (...)
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  • Voluntary sterilisation of young childless women: not so fast.Zeljka Buturovic - 2022 - Journal of Medical Ethics 48 (1):46-49.
    An increasing number of bioethicists are raising concerns that young childless women requesting sterilisation as means of birth control are facing unfair obstacles. It is argued that these obstacles are inconsistent, paternalistic, that they reflect pronatalist bias and that men seem to face fewer obstacles. It is commonly recommended that physicians should change their approach to this type of patient. In contrast, I argue that physicians’ reluctance to eagerly follow an unusual request is understandable and that whatever obstacles result from (...)
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  • More Necessary than Medical: Reframing the Insurance Argument for Transition-Related Care.Elizabeth Dietz - 2020 - International Journal of Feminist Approaches to Bioethics 13 (1):63-88.
    The healthcare system—the assemblage of hospitals, insurers, professional associations, policymakers, patients, caregivers, and other entities oriented toward health in the United States—does more than cure illness. It is, and in some cases ought to be but falls short, attentive to endpoints other than cure, such as comfort, participation in desired activities, and the creation of families—things that may broadly be understood as promoting well-being. In the United States, health care utilization is prohibitively expensive. As a result, most people can only (...)
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